7.2: Introduction to dermatology (part 2 of 2)

Question 1

Psoriasis is a

Answer 1

Chronic, immune mediated disorder

Question 2

Two triggers of psoriasis

Answer 2

Polygenic predisposition
Environmental triggers e.g trauma, infections or medications

Question 3

Characteristics of psoriasis

Answer 3

Sharply demarcated, scaly, erythematous plaques

Question 4

7 sites of involvement of psoriasis

Answer 4

Scalp, elbows, knees, nails, hands, feet, trunk - intergluteal fold

Question 5

Most common systemic manifestation of psoriasis

Answer 5

Psoriatic arthritis

Question 6

Predispositions of psoriasis regarding lifestyle factors

Answer 6

Alcohol
Smoking
(excessive use)
Co-morbidities : elevated body mass, diabetes

Question 7

Erythroderma is

Answer 7

When more than 90% of the skin is covered
Can lead to failure in Thermoregulation

Question 8

4 Topical therapies of psoriasis

Answer 8

Vitamin D analogues
Topical corticosteroids
Retinoids (less common)
Topical tacrolimus

Question 9

The therapeutic ladder is

Answer 9

Starting with most basic management therapies such as topical therapies

Question 10

2 types of phototherapy used to manage psoriasis

Answer 10

Narrowband UVB - UVB more commonly used as has no risk of skin cancer compared to UVA
PUVA (Psoralen + UVA)

Question 11

If topical therapies tend not to work

Answer 11

Acitretin
Systemic immunosuppressives
Advanced therapies are used

Question 12

2 immunosuppressants used to manage psoriasis

Answer 12

Methotrexate
Ciclosporin

Question 13

2 advanced therapies of psoriasis

Answer 13

PDE4 inhibitors
Biologics - anti-TNF, anti-IL-17

Question 14

Atopic eczema is a

Answer 14

Intensely pruritic chronic inflammatory condition

Question 15

What kind of disease is eczema

Answer 15

Complex genetic disease with environmental influences

Often associated with other atopic disorders

Question 16

Time of onset of eczema

Answer 16

Infancy or eat,y childhood

Question 17

Signs of eczema in infants

Answer 17

A true inflammation of cheeks, scalp and extensors

Question 18

Signs of eczema in children and adults

Answer 18

Flexural inflammation and lichenification

Question 19

Common management of eczema

Answer 19

Daily emollients, anti-inflammatory therapy

Question 20

Two main components of eczema pathophysiology

Answer 20

Barrier defects -> increased transepidermal water loss (TEWL)
Immune dysregulation

Question 21

Golden appearance of eczema is called

Answer 21

Impetiginisation - due to staphylococcus aureus

Question 22

Eczema in older patients in both limbs can be due to

Answer 22

Lymph fluid restriction leading to venous status eczema

Question 23

Sudden onset of Monomorphic erosions show signs of (emergency)

Answer 23

Eczema herpeticum
- increases risk of HSV

Question 24

Primary management of atopic eczema

Answer 24

Lifestyle factors :
Emollients
Omission of soap

Question 25

Further management of atopic eczema

Answer 25

Clinical nurse specialist involvement Topical application technique Day treatment Habit reversal Co-morbidities Patch testing Biopsy- nickel eczema not responding to treatment have to differentiate between breast carcinoma

Question 26

Therapeutic ladder of eczema management

Answer 26

Topical therapies : topical corticosteroids Topical tacrolimus Phototherapy : Narrowband UVB PUVA

Question 27

Topical immunodulatories have an important role in

Answer 27

Management of eczema

Question 28

Potential use of topical immunomodulatories

Answer 28

Underuse (poor adherence) Overuse of topical corticosteroids

Question 29

Counselling is crucial when using topical immunomodulatories

Answer 29

Correct steroid for correct site Adverse effects Amount of use

Question 30

Topical steroid ladder

Answer 30

Increasing potency of steroid treatments Hydrocortisone is the weakest steroid Clobetasol in the most potent

Question 31

Eczema management using systemic immunosuppression (3)

Answer 31

Methotrexate Crclosporin Azathioprine

Question 32

2 advanced therapies of eczema

Answer 32

Biologics JAK inhibitors

Question 33

What can atopic eczema be complicated by

Answer 33

Life threatening HSV infection